A 84-year-old woman, independent and fairly active for her age and on medication for moderate systolic hypertension is presenting to her family physician’s office with recent complaints of palpitation, that she describes as “thumps” in her chest:

• Sinus rhythm with premature atrial complexes in a pattern of trigeminy
• Voltage criteria for left ventricular hypertrophy

Every third beat is a premature atrial complex (“trigeminal” pattern).

The family physician has reassured the patient and no change in her therapy is required.